The American journal of emergency medicine · 2025
Frontal QRS-T angle as an early predictor of mortality in Sepsis.
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Çaprak Rukiye, Oğuzlar Furkan Çağrı, Armağan Hamit Hakan, Cesur Ezgi
Аннотация
BACKGROUND: Sepsis frequently results in early death, especially among elderly individuals and those with underlying chronic illnesses. Timely and accurate risk assessment remains a major clinical challenge. The frontal QRS-T (F-QRS-T) angle, derived from standart electrocardiograpraphy (ECG), reflects the heterogeneity in ventricular repolarization dynamics, has emerged as a potential prognostic tool in various inflammatory and cardiovascular disorders. This research investigated whether the F-QRS-T angle obtained upon emergency department admission could serve as an early predictor of outcome in sepsis.
METHODS: This retrospective cohort study was conducted between September 2022 and September 2024 in a tertiary emergency care facility of a university hospital in Türkiye. Adult patients meeting Sepsis-3 criteria with a 12‑lead ECG recorded within one hour of presentation were included. Demographic, clinical, laboratory, and ECG data were retrieved from electronic health records. The main outcome of interest was all-cause mortality occurring within 30 days of hospital admission.
RESULTS: The study cohort comprised 456 individuals, with a mean age of 71.7 ± 13.5 years, and 55.5 % identified as male. Within 30 days, 32.9 % of patients in the cohort had died. Non-survivors had significantly higher F-QRS-T angles than survivors (85.0° vs. 55.2°, p < 0.001). A cut-off value of 43.5° provided the best discrimination for mortality, yielding an AUC of 0.750, sensitivity of 65.4 %, and specificity of 72.2 %. The F-QRS-T angle increased progressively across higher MEWS and qSOFA categories and was significantly elevated in patients with septic shock. In multivariable Cox regression, a widened F-QRS-T angle remained an independent predictor of mortality (HR = 2.805, 95 % CI: 1.797-4.378), alongside elevated CRP, lactate, and MEWS ≥2.
CONCLUSION: The frontal QRS-T angle is an independent, non-invasive predictor of 30-day mortality in sepsis. Its routine availability on standard ECGs makes it a practical adjunct to existing scoring systems for early risk stratification in the emergency setting.
METHODS: This retrospective cohort study was conducted between September 2022 and September 2024 in a tertiary emergency care facility of a university hospital in Türkiye. Adult patients meeting Sepsis-3 criteria with a 12‑lead ECG recorded within one hour of presentation were included. Demographic, clinical, laboratory, and ECG data were retrieved from electronic health records. The main outcome of interest was all-cause mortality occurring within 30 days of hospital admission.
RESULTS: The study cohort comprised 456 individuals, with a mean age of 71.7 ± 13.5 years, and 55.5 % identified as male. Within 30 days, 32.9 % of patients in the cohort had died. Non-survivors had significantly higher F-QRS-T angles than survivors (85.0° vs. 55.2°, p < 0.001). A cut-off value of 43.5° provided the best discrimination for mortality, yielding an AUC of 0.750, sensitivity of 65.4 %, and specificity of 72.2 %. The F-QRS-T angle increased progressively across higher MEWS and qSOFA categories and was significantly elevated in patients with septic shock. In multivariable Cox regression, a widened F-QRS-T angle remained an independent predictor of mortality (HR = 2.805, 95 % CI: 1.797-4.378), alongside elevated CRP, lactate, and MEWS ≥2.
CONCLUSION: The frontal QRS-T angle is an independent, non-invasive predictor of 30-day mortality in sepsis. Its routine availability on standard ECGs makes it a practical adjunct to existing scoring systems for early risk stratification in the emergency setting.